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HOME > Clin Endosc > Volume 58(6); 2025 > Article
Review Advancing colonoscopy training: tailored strategies and simulation-based models for skill mastery
Nilanga Nishad1orcid, Malith Nandasena2orcid, Andreas Hadjinicolaou3orcid, Mo Hameed Thoufeeq1,4orcid
Clinical Endoscopy 2025;58(6):808-816.
DOI: https://doi.org/10.5946/ce.2025.019
Published online: June 9, 2025

1Department of Gastroenterology, Sheffield University Hospitals NHS Trust, Sheffield, UK

2Department of Surgery, University of Sri Jayawardenapura Sri Lanka, Colombo, Sri Lanka

3Department of Gastroenterology, Cambridge University Hospital, NHS Trust, Cambridge, UK

4Clinical Lead (joint) Endoscopy South Yorkshire ICB, Sheffield, UK

Correspondence: Nilanga Nishad Department of Gastroenterology, Sheffield University Hospitals NHS Trust, Herries Road, Sheffield, S5 6WB, UK E-mail: nilanga.nishad@nhs.net
• Received: January 13, 2025   • Revised: March 4, 2025   • Accepted: March 9, 2025

© 2025 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Effective endoscopy training begins by assessing the trainee’s experience and identifying their skill level: beginners, learners, independent practitioners, or experts. Beginners focus on basic tasks, such as cecal intubation, while advanced trainees refine efficiency and complex techniques. Training prioritizes conscious competence through deliberate practice, reflection, and verbalizing actions; this enhances mindfulness and procedural expertise. Clear communication, standardized terminology, and constructive feedback ensure safety, confidence, and skill retention. SMART objectives—specific, measurable, achievable, relevant, and timely—help structure sessions for skill development and mastery. Simulation-based models support training at all the levels. Beginners benefit from cost-effective low-fidelity bench models and virtual reality (VR) simulators, which offer realistic tactile feedback and customizable scenarios. Studies have shown that both low- and high-fidelity models can effectively teach basic skills, although VR is preferred for foundational training. Advanced trainees utilize animal-based models for therapeutic interventions, three-dimensional printed models for pathology-specific practice, and hybrid models that combine VR and physical elements for enhanced realism. Augmented reality and haptic feedback systems refine advanced skills, but face developmental and cost challenges. Mentored live patient models excel in real-world decision-making, but raise ethical concerns. Training is tailored to individual needs, and competency-based training ensures mastery at each stage, from beginners to advanced practitioners.
  • Keywords: Colonoscopy; Competency; Endoscopy training; Simulation
The Training the Colonoscopy Trainer (TCT) program in the United Kingdom (UK) was introduced in 2004 to improve endoscopy training and ensure high-quality outcomes in colonoscopy. It was developed in conjunction with the English National Health Service initiative to enhance service delivery and training standards through audits, highlighting training deficiencies.
The TCT program has improved colonoscopy outcomes in the UK and has been adopted internationally as well. The principles of the TCT program are similar to surgical technique training including laparoscopic surgery and other endoscopic techniques.1
This review was written as a knowledge refresher for experienced colonoscopists who are currently involved in training after attending a TCT course, as a rough guide for colonoscopists who have not attended a course to develop their skills as trainers, and for the trainees to understand how the trainer thinks about the training.
Assessing the endoscopy experience of a trainee is crucial for effective teaching. This includes evaluating their gastroscopy skills, colonoscopy exposure, and the training stage. Identifying key performance indicators (KPIs) and proficiency levels—beginner, learner, independent, or expert—helps tailor instructions. Understanding their competencies allows educators to provide targeted guidance as different trainees progress at different rates. Regular assessment of procedural skills ensures a personalized learning plan, enhancing skill development and confidence in endoscopy. Adapting training to individual needs improves overall educational outcomes. Technical KPIs include a cecal intubation rate of at least 90%, a withdrawal time of six minutes in negative procedures, and an adenoma detection rate of at least 25%. Safety measures such as perforation rates below 0.1%, post-polypectomy bleeding rates <1%, and appropriate sedation help minimize risks. Quality and training KPIs emphasize proper documentation, patient comfort, loop management, cecal intubation time, and therapeutic success. Additionally, maintaining an annual case volume of at least 100 procedures ensures ongoing competency.2 Proficiency levels in colonoscopy training typically progress through several stages. (1) Beginner: individuals with minimal or no experience in colonoscopy. (2) Learner: trainees actively acquiring skills under supervision, focusing on developing techniques and understanding procedural nuances. (3) Independent practitioner: endoscopists who have achieved competency, perform procedures without direct supervision, and consistently meet established KPIs. (4) Expert: highly experienced practitioners who not only perform colonoscopies proficiently but also contribute to the training, mentorship, and advancement of endoscopic practices.
This process begins by asking the trainees about their comfort level with the procedure and their perceived areas of improvement. For instance, a novice may focus on reaching the cecum independently, whereas an advanced trainee may concentrate on mastering complex polypectomy techniques or improving procedural efficiency. When working with a trainee for the first time or after a significant break, trainers should review prior evaluations or consult the program leadership to better align their teaching with the trainee’s needs.3,4
Colonoscopy trainees often present broad or undefined objectives, and it is the trainer’s responsibility to refine these objectives into meaningful ones. In the context of an endoscopy teaching event, objectives can be set before the training session using tools such as SMART (specific, measurable, achievable, relevant, and timely).5
To achieve these objectives, the trainer must first understand the trainee’s level of competence. This information is important for colonoscopy training because the rate-limiting step in new information storage is the amount of previous knowledge present in an individual’s memory.6 Second, there should be an agreement between the trainer and the trainee on objectives and expectations, a process known as aligning agendas.7 Objectives such as “reaching the cecum” or “scoping to the transverse colon” may not be realistic for a novice trainee, given their current level of competence. Instead, trainers should apply the SMART framework to tailor objectives that align with the trainee's skill level and progression, to ensure that each session contributes to their development in a structured and attainable manner). Colonoscopy training integrates motor and cognitive skills. Trainees must master correct colonoscope handling, control use, insertion, advancement, torque, loop reduction, angulated turns, and terminal ileum intubation. Key cognitive domains include anatomy, patient selection, preparation, colonoscope and sedation choice, informed consent, indication and risk assessment, lumen identification, pathology recognition, mucosal inspection during withdrawal, therapeutic device use, biopsy, snare polypectomy, complication management, and integration of findings into management plans. Emphasis on report generation, communication, professionalism, and continuous quality improvement is essential.8-10
Some of the objectives that the trainer can suggest are (1) Scope introduction: identifying the parts of the colonoscope and holding it correctly. (2) Scope handling: effective scope handling is essential for successful navigation. Trainees should practice keeping the colonoscope straight and neutral to achieve one-to-one movement, utilize torque steering with the right hand, and minimize gas insufflation during insertion. Small, precise, and controlled movements are preferred over rapid changes in direction. (3) Different scopes: pediatric vs. adult: understanding the differences between pediatric and adult colonoscopes is vital. Pediatric colonoscopes are thinner and more flexible, making them suitable for patients with narrower or more tortuous colons. (4) Scope functions: trainees must familiarize themselves with the functions of the colonoscope, including the tip deflection controls (up/down and left/right), air/water insufflation, suction, and accessory channels for biopsy or polypectomy. (5) Torque steering: torque steering involves rotating the scope shaft to navigate the colonic curves effectively. Combining shaft rotation with appropriate tip angulation minimizes loop formation and facilitates a smoother advancement through the colon. (6) Identification of loop formation: recognizing loop formation is crucial. Indicators include loss of one-to-one movement between the scope and tip, paradoxical tip motion, increased resistance, and patient discomfort. Visual cues such as mucosal blanching may also suggest excessive force against the colonic wall. (7) Loop prevention: preventing loops involves techniques such as torque steering, minimizing insufflation, frequent withdrawal movements combined with suction, and appropriate patient positioning. Maintaining a straight scope and avoiding over-angulation are also key strategies. (8) Loop resolution: when loops occur, resolving them requires withdrawing the scope with applied torque (clockwise or counterclockwise), changing the patient's position, or applying external abdominal pressure. These maneuvers help straighten the scope and allow readvancement. (9) Scope withdrawal techniques: withdrawals should be slow and methodical, allowing thorough mucosal inspection of polyps or lesions. Adequate visualization is achieved by cleaning the mucosa, aspirating the residual fluid, and ensuring proper luminal distension. (10) Cecal retroflexion: retroflexion in the cecum involves bending the tip of the scope backward to examine the ileocecal valve and appendiceal orifice. This maneuver provides a better view of these areas, potentially increasing the polyp detection rates. (11) Rectal retroflexion: rectal retroflexion allows visualization of the distal rectum and the anal canal. This aids in detecting lesions that may be missed during forward view. Trainees should practice this maneuver to enhance comprehensive examination of the rectal area.
Being the conscious competent
During colonoscopy training, the ability to execute a skill deliberately and accurately is more critical than automatically performing actions without awareness (unconscious competence). Most colonoscopists are in the stage of unconscious competence (Fig. 1).11 For them, achieving conscious competence is challenging but essential for effective teaching and learning, as it enables the trainer to explain the techniques. An effective strategy for developing this skill is to verbalize actions during endoscopy. This process encourages mindfulness and reinforces procedural knowledge by linking one’s thoughts and improving teaching capabilities.1,3 Regular reflection and deliberate practice are key components in the transition to conscious competence in guiding others.12
Aligning the agenda, ground rules
Aligning the agenda and establishing clear ground rules are vital for effective colonoscopy training. This creates a structured learning environment in which expectations are set and both the trainer and trainee understand their roles. For instance, ground rules, such as allowing the trainer to stop the trainee when necessary, would ensure patient safety and provide opportunities for immediate correction and feedback. This structure fosters trust and enhances learning efficiency by minimizing misunderstandings and focusing on skill development.13 Setting clear expectations also helps trainees feel supported and enables them to take constructive risks while learning.14 Moreover, a well-aligned agenda ensures that training sessions are goal oriented and tailored to the trainee’s specific needs, promoting incremental skill acquisition.15
Clear, conscious comments
In colonoscopy training, it is essential to establish consistent and straightforward vocabulary. Terms like “big wheel up,” “big wheel inwards,” and “big wheel towards you,” along with phrases like “look up” are some of the terms used by different endoscopists without uniformity. Recent studies have emphasized the importance of standardized terminology in enhancing procedural efficiency and reducing errors during endoscopy training. By adopting these consistent phrases, trainees can easily understand the language even when working with different trainers.16,17 The following are some of the important and essential words that we suggest: “advance, withdraw, clock, anti-clock, tip-up, tip-down, tip-left, tip-right, suck, blow, flush, slow down, stop/pause, water, change position, pressure.”
Effective guidance from colonoscopy trainers during the procedure should prioritize being clear, calm, concise, consistent, and using commonly used language. Trainers should regularly check for understanding and avoid causing cognitive overload, which is often referred to as dual-task interference.18 Feedback should be constructive and meaningful, ensuring that encouragement is paired with specific reasons to enhance the trainee's learning experience. For instance, instead of a generic compliment, a trainer might say, “Excellent work! You recognized sigmoid loop formation early and promptly adjusted the position.” This targeted feedback reinforces critical skills and improves retention. Specific praise boosts trainee confidence and learning efficiency.19
Effective training relies on good communication and a shared common language. Trainers should adapt their style to the trainee’s needs, combining directive instructions like “stop, push, inflate” with observational comments such as “the lumen is poorly inflated” to guide focus. Encouraging problem-solving through questions—“what’s the problem? what are the options?”—builds critical thinking skills, with directives reserved for moments when the trainee needs more support.
Performance-enhancing feedback
Effective feedback for colonoscopy training should involve a structured approach that acknowledges the strengths, encourages self-reflection, and provides clear paths for improvement. The trainer should begin by recognizing what the trainee did well, adding positive points where applicable, and then prompting the trainee with open-ended questions such as “How did that go?” or “How was it for you?” To foster reflection on and discussion of challenges. Areas for improvement were addressed collaboratively by confirming the trainee’s observations and supplementing them with additional insights. The session concludes with a concise summary of two to three key take-home messages, providing a clear plan for future development. Performance-enhancing feedback, when delivered in a constructive and reflective manner, improves procedural proficiency and trainee confidence.20
Setting some new objectives for the next session after a successful colonoscopy training is essential to maintain momentum and ensure continued growth. This allows the trainees to build on their newly acquired skills while addressing areas for further improvement. Clear incremental objectives provide structure, helping trainees focus on specific tasks that enhance their competence and confidence. This forward-planning approach fosters a sense of progression and aligns learning with long-term goals. Additionally, collaborative goal setting between the trainer and the trainee reinforces accountability and engagement, making the learning process more personalized and effective.
Simulation-based models for colonoscopy training encompass a range of tools, each with distinct advantages and limitations that cater to the various stages of skill development and training objectives. They range from simple low-fidelity to high-fidelity models. Low-fidelity bench models, such as styrofoam representations of colon anatomy, offer an affordable option for beginners but lack the realism and tactile features of real tissues.21 Virtual reality (VR) simulators use computer-generated environments to provide realistic tactile feedback and customizable scenarios, allowing repeatable training sessions. However, these methods are expensive and cannot fully replicate real patient variability.22 Novice trainees in basic colonoscopy training can benefit from both the VR and physical model simulators (Table 1).23
Some studies have shown that colonoscopy skill training using a low-fidelity model appears to be as effective as high-fidelity model training for basic endoscopic skill acquisition in novice learners.24
Animal-based models, including live or excised porcine models, provide high anatomical fidelity and are valuable for therapeutic interventions such as endoscopic submucosal dissection.25 However, these systems face ethical concerns, high maintenance costs, and logistical challenges. Similarly, three-dimensional (3D)-printed models deliver anatomically accurate, customizable structures that replicate specific pathologies in a cost-effective manner. However, they remain static and fail to simulate dynamic processes such as peristalsis or live tissue interaction.26
One disadvantage of the simulation models is the lack of feedback. Hybrid models integrate VR and physical components to combine the advantages of both and enhance realism and interactivity. A hybrid (physical and computer) colonoscopy training simulator was developed using a novel pressure-sensing sleeve covering the full length of the colonoscope, a physical colon simulator (Kyoto Kagaku), and custom-designed training software. This visualizes the color-mapped 3D pressure profile of the colonoscope during the simulated procedure and provides a visual and quantitative evaluation of the endoscopist’s skills after the procedure. However, these devices are expensive and require technical expertise for maintenance.27
AR models overlay digital images onto real-world settings to integrate real-time feedback with physical interactions, which is a promising innovation in advanced skill training. However, this technology is still under development and is associated with high costs and hardware requirements. These can provide feedback during and after the procedure, which was found to be useful by participants in such studies.28
Training on mentored live patient models provides exposure to realistic, variable anatomy and is excellent for honing clinical decision-making skills. However, this raises ethical concerns, risks patient harm, and offers limited opportunities in practice. Haptic feedback systems focus on replicating the tactile sensation of colonoscope manipulation and improving manual dexterity but often lack visual realism and comprehensive procedure simulation. According to medical experts, haptic realism is difficult to achieve, and it is even more difficult to achieve inter-expert agreement on the haptic feedback of one simulation. However, haptic feedback is important in medical training and allows educators to share the forces experienced during a procedure if they know and trust what a particular virtual simulator will provide to the trainee.29
These simulation models collectively provide a diverse toolkit for colonoscopy training, balancing costs, realism, and skill development opportunities tailored to specific training needs (Fig. 2).27
A direct comparison of simulation-based models for colonoscopy training is lacking in the literature. A study by Mu et al.23 demonstrated that a VR simulator is more beneficial than a physical model for colonoscopy training, making it the preferred choice for beginners. Studies in other fields have not definitively established the superiority of VR or physical models. However, other studies have suggested that VR training improves skill performance.30,31
Colonoscopy training progresses through distinct stages, each emphasizing specific skills and methods. At the beginner stage, trainees focus on mastering basic technical skills and scope handling in a risk-free environment with methods such as VR training, low-fidelity 3D models, and gamification, providing accessible and engaging learning. The intermediate stage introduces more realistic scenarios, emphasizing advanced navigation and procedural refinement through tools, such as 3D-printed models, artificial intelligence (AI)-driven feedback, augmented reality, and telementoring. In the advanced stages, training shifts to real patient procedures, decision-making, complex therapeutic interventions, leveraging AI systems, patient-centered metrics, telementoring, and cultural competency training (Table 2). Competency-based training spans all stages, ensuring that trainees meet predefined benchmarks tailored to their progression.
Effective endoscopy training should be aligned with the trainee’s skill level, ensuring progressive skill acquisition from beginners to experts. Training fosters conscious competence through deliberate practice, reflection, and verbalization; this reinforces mindfulness and procedural expertise. Clear communication, standardized terminology, and constructive feedback play crucial roles in skill retention and confidence-building. Simulation-based models support training at all levels, with low-fidelity bench models and VR Simulators aiding beginners, whereas advanced trainees benefit from animal-based models, 3D-printed models, and hybrid systems. Emerging technologies, such as AR and haptic feedback, enhance realism but face developmental barriers. Ultimately, competency-based training ensures mastery at each stage, providing a tailored approach that balances technical proficiency with real-world applications, and fosters safe and effective endoscopists.
Fig. 1.
The four stages of conscious competence model.
ce-2025-019f1.jpg
Fig. 2.
Simulation-based models. (A) Low-fidelity model of a colon that can be bought with USD 180-260 online (Shanghai Honglian Medical Instrument Development Co., Ltd.). (B) Colonoscope Training Simulator (Kyoto Kagaku). (C) ENDO Suite-GI Mentor; Surgical Science. The GI Mentor is an evidence-based simulator family for training in upper and lower gastrointestinal endoscopic procedures. It offers a comprehensive library of modules, with more than 120 tasks and virtual patient cases. (D) Colonoscopy graphical user interface with (a) procedure screen with pre-recorded colonoscopy procedure, timer, force warning, and polyp detection counter, and (b) procedure summary screen with feedback indicators such as the overall score. Adapted from Elsaadany et al. Proc Hum Factor Ergon Soc Annu Meet 2024;68:1071–1077, according to the Creative Commons license.27
ce-2025-019f2.jpg
Table 1.
Simulation-based models for colonoscopy training: a comparative overview
Simulation model Description Advantages Limitations
VR simulators Use computer-generated environments to replicate colonoscopy procedures. Realistic tactile feedback, customizable scenarios, repeatable training sessions. High cost; lacks exact replication of real patient variability.
Low-fidelity bench models Physical models with simple structures to mimic colon anatomy (e.g., styrofoam models). Low cost; suitable for early stages of skill acquisition. Limited realism; does not simulate mucosal texture or tactile resistance of real colon tissues.
Animal-based models Live or excised porcine models used to simulate human colonoscopy. High anatomical fidelity; good for practicing therapeutic interventions. Ethical concerns; high maintenance costs; logistical challenges.
3D-printed models Anatomically accurate colon models created using 3D printing technology. Customizable, cost-effective, durable; can replicate specific pathologies. Static structures; limited dynamic simulation of peristalsis or live tissue interactions.
Hybrid models Combination of VR and physical models, integrating digital and tactile components. Combines advantages of VR and bench models; enhances realism and interactivity. Expensive; requires technical expertise to develop and maintain.
AR models Overlays digital images onto real-world settings, enhancing physical models or live videos. Integrates real-time feedback with physical interaction; innovative for advanced skill training. Technology still in development; high costs; requires additional hardware.
Mentored live patient models Supervised training on actual patients under controlled conditions. Provides realistic, variable anatomy; excellent for assessing clinical decision-making skills. Risk of patient harm; ethical concerns; limited practice opportunities.
Haptic feedback systems Standalone systems focusing on replicating the tactile sensation of colonoscope manipulation. Improves manual dexterity and loop management skills. Often lacks visual realism; does not simulate full procedures.
Telementoring and remote training Real-time guidance from experts via live video or augmented platforms. Expands access to expert mentorship; reduces geographical barriers. Requires robust internet connectivity and compatible devices; limits tactile guidance.
Cultural competency training Emphasizes understanding diverse patient populations and improving communication skills. Enhances patient satisfaction; reduces disparities in care. Requires additional training modules; may increase training duration.
AI-driven feedback systems Automated systems providing performance evaluation based on procedural data and video analysis. Offers detailed, unbiased assessments; helps identify areas of improvement. Requires integration with compatible hardware; may face resistance from traditional training systems.

VR, virtual reality; 3D, three-dimensional; AR, augmented reality; AI, artificial intelligence.

Table 2.
Possible uses of simulation-based models for colonoscopy training at different stages of colonoscopy training
Method Training stage Rationale
Virtual reality training Beginner to intermediate Ideal for learning basic scope navigation, loop reduction, and mucosal inspection in a risk-free environment.
AI Intermediate to advanced Supports skill refinement, real-time lesion detection, and procedural accuracy during clinical practice.
Three-dimensional -printed colon models Beginner to intermediate Useful for basic scope handling, anatomical familiarity, and practicing therapeutic interventions.
Augmented reality Intermediate to advanced Enhances live procedural training with advanced visualization and real-time feedback on anatomy and pathology.
Competency-based training All stages Adaptable for all skill levels; ensures mastery of specific competencies before progressing to more advanced tasks.
Telementoring and Remote Training Intermediate to advanced Suitable for trainees who can perform basic procedures and benefit from expert guidance for advanced cases.
Gamification of training Beginner Engages early learners by making skill acquisition enjoyable while building procedural knowledge.
Patient-centered metrics Advanced Emphasized when trainees handle live patients, focusing on safety, comfort, and communication skills.
AI-driven feedback systems Intermediate to advanced Provides data-driven evaluations during real or simulated procedures to refine technique and performance.
Cultural competency training Advanced Appropriate for trainees transitioning to independent practice, ensuring effective communication with diverse populations.

AI, artificial intelligence.

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        Advancing colonoscopy training: tailored strategies and simulation-based models for skill mastery
        Clin Endosc. 2025;58(6):808-816.   Published online June 9, 2025
        DOI: https://doi.org/10.5946/ce.2025.019
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      Advancing colonoscopy training: tailored strategies and simulation-based models for skill mastery
      Image Image
      Fig. 1. The four stages of conscious competence model.
      Fig. 2. Simulation-based models. (A) Low-fidelity model of a colon that can be bought with USD 180-260 online (Shanghai Honglian Medical Instrument Development Co., Ltd.). (B) Colonoscope Training Simulator (Kyoto Kagaku). (C) ENDO Suite-GI Mentor; Surgical Science. The GI Mentor is an evidence-based simulator family for training in upper and lower gastrointestinal endoscopic procedures. It offers a comprehensive library of modules, with more than 120 tasks and virtual patient cases. (D) Colonoscopy graphical user interface with (a) procedure screen with pre-recorded colonoscopy procedure, timer, force warning, and polyp detection counter, and (b) procedure summary screen with feedback indicators such as the overall score. Adapted from Elsaadany et al. Proc Hum Factor Ergon Soc Annu Meet 2024;68:1071–1077, according to the Creative Commons license.27

      Fig. 1.

      Fig. 2.

      Advancing colonoscopy training: tailored strategies and simulation-based models for skill mastery
      Simulation model Description Advantages Limitations
      VR simulators Use computer-generated environments to replicate colonoscopy procedures. Realistic tactile feedback, customizable scenarios, repeatable training sessions. High cost; lacks exact replication of real patient variability.
      Low-fidelity bench models Physical models with simple structures to mimic colon anatomy (e.g., styrofoam models). Low cost; suitable for early stages of skill acquisition. Limited realism; does not simulate mucosal texture or tactile resistance of real colon tissues.
      Animal-based models Live or excised porcine models used to simulate human colonoscopy. High anatomical fidelity; good for practicing therapeutic interventions. Ethical concerns; high maintenance costs; logistical challenges.
      3D-printed models Anatomically accurate colon models created using 3D printing technology. Customizable, cost-effective, durable; can replicate specific pathologies. Static structures; limited dynamic simulation of peristalsis or live tissue interactions.
      Hybrid models Combination of VR and physical models, integrating digital and tactile components. Combines advantages of VR and bench models; enhances realism and interactivity. Expensive; requires technical expertise to develop and maintain.
      AR models Overlays digital images onto real-world settings, enhancing physical models or live videos. Integrates real-time feedback with physical interaction; innovative for advanced skill training. Technology still in development; high costs; requires additional hardware.
      Mentored live patient models Supervised training on actual patients under controlled conditions. Provides realistic, variable anatomy; excellent for assessing clinical decision-making skills. Risk of patient harm; ethical concerns; limited practice opportunities.
      Haptic feedback systems Standalone systems focusing on replicating the tactile sensation of colonoscope manipulation. Improves manual dexterity and loop management skills. Often lacks visual realism; does not simulate full procedures.
      Telementoring and remote training Real-time guidance from experts via live video or augmented platforms. Expands access to expert mentorship; reduces geographical barriers. Requires robust internet connectivity and compatible devices; limits tactile guidance.
      Cultural competency training Emphasizes understanding diverse patient populations and improving communication skills. Enhances patient satisfaction; reduces disparities in care. Requires additional training modules; may increase training duration.
      AI-driven feedback systems Automated systems providing performance evaluation based on procedural data and video analysis. Offers detailed, unbiased assessments; helps identify areas of improvement. Requires integration with compatible hardware; may face resistance from traditional training systems.
      Method Training stage Rationale
      Virtual reality training Beginner to intermediate Ideal for learning basic scope navigation, loop reduction, and mucosal inspection in a risk-free environment.
      AI Intermediate to advanced Supports skill refinement, real-time lesion detection, and procedural accuracy during clinical practice.
      Three-dimensional -printed colon models Beginner to intermediate Useful for basic scope handling, anatomical familiarity, and practicing therapeutic interventions.
      Augmented reality Intermediate to advanced Enhances live procedural training with advanced visualization and real-time feedback on anatomy and pathology.
      Competency-based training All stages Adaptable for all skill levels; ensures mastery of specific competencies before progressing to more advanced tasks.
      Telementoring and Remote Training Intermediate to advanced Suitable for trainees who can perform basic procedures and benefit from expert guidance for advanced cases.
      Gamification of training Beginner Engages early learners by making skill acquisition enjoyable while building procedural knowledge.
      Patient-centered metrics Advanced Emphasized when trainees handle live patients, focusing on safety, comfort, and communication skills.
      AI-driven feedback systems Intermediate to advanced Provides data-driven evaluations during real or simulated procedures to refine technique and performance.
      Cultural competency training Advanced Appropriate for trainees transitioning to independent practice, ensuring effective communication with diverse populations.
      Table 1. Simulation-based models for colonoscopy training: a comparative overview

      VR, virtual reality; 3D, three-dimensional; AR, augmented reality; AI, artificial intelligence.

      Table 2. Possible uses of simulation-based models for colonoscopy training at different stages of colonoscopy training

      AI, artificial intelligence.

      Table 1.

      Table 2.

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